The primary strategy for reducing heart disease in populations is to follow international guidelines, such as those suggested by the British Heart Foundation (BHF) and the World Health Organisation.
These broadly recommend reducing total fat and saturated fat intakes, replacing saturated fat with small amounts of unsaturated fats, reducing salt intake, maintaining a healthy weight and limiting alcohol consumption.
“A healthy, balanced diet can be achieved by following the UK government’s Eatwell plate model, which includes plenty of starchy foods, lean protein sources such as lean meat and poultry, low-fat dairy products, pulses nuts and seeds, plenty of fruit and vegetables, and oily fish,” says Dr Stacey Lockyet, nutrition scientist at the British Nutrition Foundation (BNF).
But what of the heart-health ingredients generated by the food industry? Where do plant and cocoa flavanols, probiotics, omega-3s, vitamin E and beta glucans to name but a few fit into the guidance doled out by nutritionists, medical practitioners and health groups?
In no uncertain terms, Victoria Taylor, senior dietician with the BHF, sets out where she sees ingredients such as these fitting into the diet. “It must be remembered that ingredients with a heart health benefit should only be used as an adjunct to a healthy, balanced diet, not a replacement for one, and they won’t be a substitute for prescribed medication,” she says.
Interestingly, ingredients giant DSM views the healthcare channel as an increasingly important route to consumers. In August, it chaired a scientific symposium at the European Society of Cardiology Congress to raise awareness of the role of nutrition as part of a practical risk reduction approach to cardiovascular health concerns.
While it isn’t suggesting that food ingredients can replace drugs such as statins in lowering blood cholesterol (low-density lipoproteins or LDL) levels, it does see them as an alternative or complementary solution to drugs.
To illustrate this, DSM global marketing manager Ruedi Duss points out that patients on statins can reduce their LDL cholesterol by a further 10% by taking beta glucans, and that Fruitflow, DSM’s water soluble tomato extract, could serve as an alternative to aspirin for circulation problems.
“Three in 10 people suffer side effects from taking aspirin,” he says. “Fruitflow enables healthy bloodflow by inhibiting platelet aggregation, an effect that is supported by an article 13.5 [health] claim.”
The BNF’s Lockyet is involved in an EU project, Bacchus, to generate tools that can establish whether a causal relationship exists between consumption of bioactive peptides and polyphenols and heart health. At present, though, she says she “wouldn’t like to speculate on whether the research will result in a sufficiently strong evidence base”.
As for other ingredients and components, Lockyet acknowledges that some have been shown to have particular benefits for cardiovascular disease prevention, for example beta glucans, stanols and sterols, via a cholesterol lowering mechanism.
“The ingredients industry has an important role in educating consumers where such benefits exist and have been agreed by EFSA [the European Food Safety Authority] and to support research to identify novel ingredients that may help in the future,” she says.
The ingredients highlighted by Lockyet are probably the most established in terms of science and awareness, but there are many more emerging. Some of these are existing ingredients, such as vitamin K and probiotics, for which new benefits are being discovered.
“Probiotics definitely have a role to play in the cardiovascular area as we have seen that some strains might positively affect blood lipids, including cholesterol,” says Eric Chappuis, director at consulting and research and development company NaturAlpha. “Furthermore, their safety profile is established and consumer recognition is high.”
This observation is seconded by Peter Wennstrom, founder of the Healthy Marketing Team, who says: “The use of probiotics to reduce cholesterol is one of the most developed areas of microbial science with safety, tolerance and the mechanism of action deconjugation of bile salts by microbial bile salt hydrolases understood.”
Governments and health organisations are not likely to start advising people to consume probiotics twice daily any time soon. But regardless of official advice, presumably there is still a receptive market for science-backed ingredients in food products and supplements positioned on a heart-health basis?
Not according to Julian Mellentin, director of analysis and insights consultancy New Nutrition Business, who sees a very limited future for heart-healthy added ingredients in food and beverages.
“Consumers are over-supplied with options, and anyway, heart health is not high on their radar,” he says.
What’s more, he believes the competitive environment of drugs and naturally healthy foods puts heart-healthy added ingredients at a competitive disadvantage.
“When people want to eat for heart health, they are faced with a wealth of naturally healthy options, such as consuming more oats or oily fish or eating more dark-skinned fruit, all of which are more appealing and none of which promise to be a magic bullet. And if their cardiovascular condition is more serious, doctors prescribe drugs like statins not foods,” he says.
Mellentin uses the example of omega-3 to demonstrate how difficult it is to make a success of adding heart-healthy ingredients to foods, saying: “Over 95% of food and beverages launched with omega-3 for heart health have been withdrawn. The remainder linger in niches.”
And having an EU-approved health claim is no guarantee of success. Sirco juice, which secured the first-ever EFSA product-specific health claim for its proven benefit to improve blood circulation, is a case in point. “It has never got beyond a super-niche status and sales are far below what was expected,” notes Mellentin.
Indeed, Chappuis makes the point that “consumer recognition is the first driver in this market, even if it doesn’t mean there is any benefit”. He cities the example of policosanols, saying: “science is very controversial for their lipid-lowering activity, yet consumers seem to be receptive”.
Despite these setbacks, DSM’s Duss sees no reason why added ingredients and natural heart-healthy ingredients such as oats, beans, lentils, nuts and oily fish should not co-exist in the marketplace.
“There’s nothing wrong with advice to eat five-a-day, but it’s not always possible and practical,” he says, “If I can get my children to eat two healthy portions a day, that’s good going. We can replace some of these missing components with supplements or specially formulated foods.”
He also points out that you need to eat a lot of oats to get the 3g daily dose of beta glucan needed, and a lot of olives to get any benefits from the polyphenols.
“The challenge for the industry is to supply those active components in a reasonable serving,” he says.
His view is echoed by Wennstrom, who says: “People don’t want to have to eat three bowls of porridge to get their beta glucan. It has become a question of convenience.”
Consequently, the answer does not necessarily lie in the “dying strategy” of functional foods, cholesterol-lowering spreads or omega-3 fortified drinks, Wennstrom suggests.
His belief is that as the trend towards liquid meals gathers pace, people will increasingly be looking for nutrients or benefit-giving ingredients in stand-alone powder, shot or concentrate format to add to their juices, shakes and smoothies.
To reach the point where consumers are asking for heart-health ingredients, there’s an education job to be done. There’s certainly no reason and no room in this challenging marketplace for food and ingredient manufacturers to lose heart.
As Wennstrom points out: “Regulatory bodies and governments tend to be behind the trends. It’s the role of the industry and the media to educate, and when the market is in a good way, that education happens.”